Recurrent Clostridium Difficile Disease: Epidemiology and Clinical Characteristics

McFarland, Lynne V.; Surawicz, Christina M.; Rubin, Moshe; Fekety, Robert; Elmer, Gary W.; Greenberg, Richard N.

doi:10.1086/501553

Cited by 325 publications

(234 citation statements)

References 56 publications

(42 reference statements)

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“…In a recent systematic review, based on seven studies that represent the best available clinical research evidence on FMT for CDI, analysis concluded that most patients (83%) experience resolution of diarrhea immediately following the first FMT procedure [Guo et al 2012]. Prior to the recent outbreaks of C. difficile with increased virulence, successful treatment of CDI episodes with traditional antibiotics results in an average of 265 additional days/patient of vancomycin and 19.7 days/patient of metronidazole [McFarland et al 1999. Continued research, particularly RCTs, will be important in determining which method of delivery is the most efficacious in repopulating the protective micro-ecology of fecal flora, while also maintaining the minimal risk of adverse events, and minimizing costs.…”

Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation in relapsing Clostridium difficile infection

Rohlke

Stollman

2012

Therap Adv Gastroenterol

170

137

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Clostridium difficile infection rates are Climbing in frequency and severity, and the spectrum of susceptible patients is expanding beyond the traditional scope of hospitalized patients receiving antibiotics. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of > 90% are being consistently reported from multiple centers. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract. This review summarizes reported results, factors in donor selection, appropriate patient criteria, and the various preparations and mechanisms of fecal microbiota transplant delivery available to clinicians and patients.

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Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation in relapsing Clostridium difficile infection

Rohlke

Stollman

2012

Therap Adv Gastroenterol

170

137

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“…5 McFarland et al 6 calculated that the mean cost of treating a patient with C. difficile associated diarrhoea and its complications is US$10,970 per case. The figures from the UK are around £4000-10,000 per case.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile: How Much do Hospital Staff Know About it?

Aroori

Blencowe

Pye

et al. 2009

annals

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Ann RC oll Surg Engl 2009; 91:4 64-469 464Clostridium difficile is an opportunistic, Gram-positive, anaerobic, spore-formingb acillus. Its clinical effects can range from mild self-limiting diarrhoea to life-threatening toxic megacolon and peritonitis. After methicillin-resistant Staphylococcus aureus infection (MRSA), C. difficile is the most wide-spread hospital acquired infection in the UK. In the UK, MRSA infection rates are declining, but rates of C. difficile infection continue to rise. There are several reasons for the increasing incidence of C. difficile infection. One possible reason could be lack of awareness and adequate knowledge among healthcare professionals. There are no studies in the literature that examined the level of healthcare professional's knowledge about C. difficile infection. We,t herefore,c onducted aq uestionnaire-based survey within our hospital to address this issue. Subjects and MethodsAq uestionnaire-based survey was conducted in Weston General Hospital, UK, in January 2007. Eligible participants included doctors, nurses, dieticians, physiotherapists, and theatre staff. Participants were recruited on av oluntary SUBJECTS AND METHODS At otal of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using aq uestionnaire consisting of 17 questions covering various aspects of C. difficile. GENERAL SURGERYRESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P =0 .001) were aware of the spectrum of illnesses causedb yC. difficile.S even (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6( 33%) consultants, 21 (53%) trainees (P =n ot significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P =0 .05) and 70% of nurses correctly answered that oral metronidazolei st he drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P <0 .0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.CONCLUSIONS There is as ignificant...

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“…Th e risk factors for recurrent CDI are slightly diff erent from those for initial CDI. In a prospective study of 209 patients with recurrent CDI, logistic regression revealed only two signifi cant independent risk factors for CDI recurrence: increased age and a lower quality of health at enrollment ( 238 ). One meta-analysis of 12 studies totaling 1,382 patients with recurrent CDI and found risk factors for recurrent CDI that included continued use of non-C. diffi cile antibiotics (odds ratio (OR) = 4.23, 95 % CI 2.1 -8.5), antacids (OR = 2.1, 95 % CI 1.1 -4.1), and older age (OR = 1.6, 95 % CI 1.1 -2.4) ( 239 ).…”

Section: Conflict Of Interestmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,450

1,389

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Recurrent Clostridium Difficile Disease: Epidemiology and Clinical Characteristics

Abstract: Recurrent CDAD is a persistent disease that may result in prolonged hospital stays, additional medical costs, and rare serious complications.

Cited by 325 publications

References 56 publications

Fecal microbiota transplantation in relapsing Clostridium difficile infection

Fecal microbiota transplantation in relapsing Clostridium difficile infection

Clostridium difficile: How Much do Hospital Staff Know About it?

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

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